Abdominal Examination

Question 1

What signs are you looking for on the nails and why?

Answer 1

Clubbing - inflammatory bowel disease
Leuconychia (due to albumin) - chronic liver disease
Koilonychia - iron deficiency anaemia

Question 2

What signs are you looking for on the hands and why?

Answer 2

Xanthomata (yellow lesions on tendons) - hyperlipidaemia 
Dupuytrens contracture (thickening of palmar fascia) - alcoholic liver Diane 
Palmar erythema (red palms) - chronic liver disease

Question 3

What signs are you looking for in the eyes and why?

Answer 3

Yellow sclera - jaundice
Conjunctival pallor -anaemia
Corneal arcus and xanthelesma - hyperlipidaemia

Question 4

What signs are you looking for in the mouth and why?

Answer 4

Angular stomatitis - iron/folate/B12 deficiencies
Glossitis - iron/folate/B12 deficiencies
Ulcers - coeliac, IBD, iron deficiency

Question 5

What signs are you looking for on the chest and why?

Answer 5

Virchows node (left supraclavicular) - gastric cancer
Gynaecomastia (man boobs) - alcoholic liver disease
Spider naevi - >5 is relevant for liver disease

Question 6

What signs are you looking for on inspection of the abdomen?

Answer 6

Distension 
Dissented abdominal veins - portal hypertension 
Hernias
Scars 
Stomas

Question 7

What are the 6 Fs that can cause distention in the abdomen?

Answer 7

Fat
Fluid 
Flatus
Faeces
Foetus 
F***ing big mass

Question 8

What could cause hepatomegaly?

Answer 8

Hepatitis
Carcinoma
Cirrhosis

Question 9

What is Murphy’ sign

Answer 9

Pain on deep inspiration on palpation in the RUQ - indicates cholycystitis

Question 10

What would tinkling bowel sounds indicate?

Answer 10

Bowel obstruction

Question 11

What would absent bowel sounds indicate?

Answer 11

Ileus

Peritonitis

Question 12

How would you complete an abdominal exam?

Answer 12

Review observation chart 
Check for hernial orifices
Perform a PR exam 
Inspect external genitalia 
Request abdominal USS or Abdominal X ray if indicated